Individual provider Active NPI

Ryan Parker, NP-C

  • Nurse Practitioner
  • Maryville, IL
National Provider Identifier
1912478231
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209.018533 Issued in IL
Practice address
6812 State Route 162 Ste 202
Maryville, IL 62062-8562
Phone
(618) 288-6844
NPI assigned
Dec 14, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209.018533 IL
Nurse Practitioner 363L00000X 209.018533 IL Primary

Addresses

Primary practice location

6812 State Route 162 Ste 202
Maryville, IL 62062-8562

Mailing address

6812 State Route 162 Ste 202
Maryville, IL 62062-8562
Phone (217) 313-6566

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190613000270 IL Practitioner - Nurse Practitioner 5698008233 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson Medical Group LLCGroup PAC ID 5193792018, 136 clinicians

Practice addresses (Care Compare)

6812 State Route 162
Suite 202
Maryville, IL 62062-8562
Phone (618) 288-6844

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
74.76 of 100Reported as group
Quality
54.98
Promoting interoperability
85
Improvement activities
40
Cost
73.39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209.018533ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Medical Group, LLC CurrentSince May 13, 2019 Accepting new patients

Locations

6812 State Route 162
Ste 202
Maryville, IL 62062
Phone (618) 288-1748

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1912478231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6812 STATE ROUTE 162 STE 202",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628562",
            "telephone_number": "217-313-6566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6812 STATE ROUTE 162 STE 202",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628562",
            "telephone_number": "618-288-6844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKER",
        "first_name": "RYAN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-14",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.018533",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209.018533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

Verify at the official NPI Registry.